Protect patients with shared data about nurses diverting drugs in hospitals

Investigations and findings must be shared, especially with compact states

All too often when a nurse is terminated from a facility for drug diversion there have been multiple infractions. The terminated nurse may test positive for narcotics which were not prescribed, be unable to account for medications that were not given, returned or wasted, or simply did not follow the facility’s medication management policy. These infractions pose a serious problem for the hospital which Is exacerbated when the terminating facility knows that the individual also works at another local healthcare organization.

Unfortunately, this is not an uncommon problem for hospitals in metro areas, especially because there is also a shortage of qualified nurses. Although a complaint is filed with the state’s Board of Nursing, months can pass before the Board investigators contact the originating complainant. That is if an investigator is even assigned. In our experience, the follow up by the Board of Nursing has been inconsistent, leaving the hospital to determine their responsibilities with regard to notifying other employers of the diversion risk on a timely basis. While no one wants to cause someone to lose their job unjustly, it’s critically important, to step in to protect the patient (victim) versus protecting the nurse (diverter). We believe it is important for the Boards of Nursing to establish a strong reporting structure to share this information.  

Unique difficulties with compact states
Compact states are those that have adopted the Nursing Licensure Compact (NLC) which is an agreement between states that allow nurses to have one license but the ability to practice in other states that are part of the agreement. While this is an excellent solution to the nursing shortage, it poses an even greater challenge for preventing diversion and sharing information. Some questions to consider are:

  • How to ensure that nurses know the laws from each state?
  • Which state is responsible for monitoring education, training, investigations and the dissemination of information concerning diversion? It is the state of residency, practice or licensure? For example, in one case a nurse was fired for testing positive to a narcotic that wasn’t prescribed and removing narcotics from the dispensing system without documentation. The hospital from which she was terminated was aware she worked at another local hospital. Although the terminating hospital attempted to warn the Board of Nursing investigator and the Board of Pharmacy, this nurse worked for another year prior to being terminated from the second facility. So, ask yourself, how many patients went without proper pain control during this time period? How many mistakes happened when she was under the influence? Just because a patient did not die does not mean she did not cause great harm to patients. So, when are the nurse’s rights more important than the patients’ rights?

Alarmingly, the compact states do not require federal or state background checks on nurses, allowing for diverting nurses to slip through. There are numerous cases where a nurse practices nationwide while a hospital continues a diversion investigation concerning that individual. Even after felony charges, a nurse may obtain a traveling nurse job in one of the 24 compact states. For instance, a nurse in Wisconsin was fired from a hospital in 2007 for stealing 245 syringes of narcotics. This nurse, during the investigation, obtained a travel nurse job in North Carolina.  Six months after arriving he was restricted from working in North Carolina.  It took his home state of Wisconsin until 2009 to retract his license. 

Opioid addiction is a national epidemic, and supportive resources should be available. Helplines, addiction counselors, support services and hospital resources should address this issue. Outsourced employee assistance programs can be useful, but don’t always provide the proper levels of confidentiality. Investing resources in identifying and treating addiction is part of a sound strategy.

Despite the challenges of addiction and the toll it takes on an individual, it is clearly unacceptable to allow a nurse who is likely diverting to have continued access to medications. It is time to consider allowing terminating hospitals the ability to report the results of an internal drug diversion investigation to future employers and to develop a system for compact states to share the information on a timely basis. In a time of complex computer databases for narcotic prescriptions, criminal charges, and DNA,  an up to date and accessible database for nursing licenses should be on the top of our list of priorities.  It is our duty to protect our patients and communities from an incapacitated nurse.

References

Weber T., Ornstein C. Troubled Nurses Skip from State to State Under Compact.  ProPublica July 2010.